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Shindiapina P, Pietrzak M, Seweryn M, McLaughlin E, Zhang X, Makowski M, Ahmed EH, Schlotter S, Pearson R, Kitzler R, Mozhenkova A, Le-Rademacher J, Little RF, Akpek G, Ayala E, Devine SM, Kaplan LD, Noy A, Popat UR, Hsu JW, Morris LE, Mendizabal AM, Krishnan A, Wachsman W, Williams N, Sharma N, Hofmeister CC, Forman SJ, Navarro WH, Alvarnas JC, Ambinder RF, Lozanski G, Baiocchi RA. Immune Recovery Following Autologous Hematopoietic Stem Cell Transplantation in HIV-Related Lymphoma Patients on the BMT CTN 0803/AMC 071 Trial. Front Immunol 2021; 12:700045. [PMID: 34539628 PMCID: PMC8446430 DOI: 10.3389/fimmu.2021.700045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/13/2021] [Indexed: 12/13/2022] Open
Abstract
We report a first in-depth comparison of immune reconstitution in patients with HIV-related lymphoma following autologous hematopoietic cell transplant (AHCT) recipients (n=37, lymphoma, BEAM conditioning), HIV(-) AHCT recipients (n=30, myeloma, melphalan conditioning) at 56, 180, and 365 days post-AHCT, and 71 healthy control subjects. Principal component analysis showed that immune cell composition in HIV(+) and HIV(-) AHCT recipients clustered away from healthy controls and from each other at each time point, but approached healthy controls over time. Unsupervised feature importance score analysis identified activated T cells, cytotoxic memory and effector T cells [higher in HIV(+)], and naïve and memory T helper cells [lower HIV(+)] as a having a significant impact on differences between HIV(+) AHCT recipient and healthy control lymphocyte composition (p<0.0033). HIV(+) AHCT recipients also demonstrated lower median absolute numbers of activated B cells and lower NK cell sub-populations, compared to healthy controls (p<0.0033) and HIV(-) AHCT recipients (p<0.006). HIV(+) patient T cells showed robust IFNγ production in response to HIV and EBV recall antigens. Overall, HIV(+) AHCT recipients, but not HIV(-) AHCT recipients, exhibited reconstitution of pro-inflammatory immune profiling that was consistent with that seen in patients with chronic HIV infection treated with antiretroviral regimens. Our results further support the use of AHCT in HIV(+) individuals with relapsed/refractory lymphoma.
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Affiliation(s)
- Polina Shindiapina
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States.,Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Maciej Pietrzak
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Michal Seweryn
- Biobank Lab, Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Łódź, Łódź, Poland
| | - Eric McLaughlin
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Xiaoli Zhang
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | | | - Elshafa Hassan Ahmed
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States.,Department of Veterenary Biosciences, College of Veterenary Medicine, The Ohio State University, Columbus, OH, United States
| | - Sarah Schlotter
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Rebecca Pearson
- Department of Pathology, The Ohio State University, Columbus, OH, United States
| | - Rhonda Kitzler
- Department of Pathology, The Ohio State University, Columbus, OH, United States
| | - Anna Mozhenkova
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Jennifer Le-Rademacher
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Richard F Little
- National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Gorgun Akpek
- Pacific Central Coast Health Centers, San Luis Obispo, CA, United States
| | - Ernesto Ayala
- Department of Internal Medicine, Hematology & Oncology, Mayo Clinic, Jacksonville, FL, United States
| | - Steven M Devine
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN, United States
| | - Lawrence D Kaplan
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Ariela Noy
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, United States
| | - Uday R Popat
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Jack W Hsu
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Lawrence E Morris
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, United States
| | | | - Amrita Krishnan
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - William Wachsman
- Moores University of California San Diego Cancer Center, La Jolla, CA, United States.,Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Nita Williams
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Nidhi Sharma
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | | | - Stephen J Forman
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Willis H Navarro
- Division of Hematology/Oncology/Transplantation, University of Minnesota, Minneapolis, MN, United States.,Global Research and Development, Atara Biotherapeutics, Inc., San Francisco, CA, United States
| | - Joseph C Alvarnas
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Richard F Ambinder
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center (SKCCC), Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Gerard Lozanski
- Department of Pathology, The Ohio State University, Columbus, OH, United States
| | - Robert A Baiocchi
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States.,Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
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2
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McKay SL, Guo A, Pergam SA, Dooling K. Herpes Zoster Risk in Immunocompromised Adults in the United States: A Systematic Review. Clin Infect Dis 2021; 71:e125-e134. [PMID: 31677266 DOI: 10.1093/cid/ciz1090] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/31/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The primary reported risk factors for herpes zoster (HZ) include increasing age and immunodeficiency, yet estimates of HZ risk by immunocompromising condition have not been well characterized. We undertook a systematic literature review to estimate the HZ risk in immunocompromised patients. METHODS We systematically reviewed studies that examined the risk of HZ and associated complications in adult patients with hematopoietic cell transplants (HCT), cancer, human immunodeficiency virus (HIV), and solid organ transplant (SOT). We identified studies in PubMed, Embase, Medline, Cochrane, Scopus, and clinicaltrials.gov that presented original data from the United States and were published after 1992. We assessed the risk of bias with Cochrane or Grading of Recommendations Assessment, Development, and Evaluation methods. RESULTS We identified and screened 3765 records and synthesized 34 studies with low or moderate risks of bias. Most studies that were included (32/34) reported at least 1 estimate of the HZ cumulative incidence (range, 0-41%). There were 12 studies that reported HZ incidences that varied widely within and between immunocompromised populations. Incidence estimates ranged from 9 to 92 HZ cases/1000 patient-years and were highest in HCT, followed by hematologic malignancies, SOT, and solid tumor malignancies, and were lowest in people living with HIV. Among 17 HCT studies, the absence of or use of antiviral prophylaxis at <1 year post-transplant was associated with a higher HZ incidence. CONCLUSIONS HZ was common among all immunocompromised populations studied, exceeding the expected HZ incidence among immunocompetent adults aged ≥60 years. Better evidence of the incidence of HZ complications and their severity in immunocompromised populations is needed to inform economic and HZ vaccine policies.
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Affiliation(s)
- Susannah L McKay
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Division of Viral Diseases, National Center Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Angela Guo
- Division of Viral Diseases, National Center Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Steven A Pergam
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA.,Infection Prevention, Seattle Cancer Care Alliance, Seattle, Washington, USA
| | - Kathleen Dooling
- Division of Viral Diseases, National Center Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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3
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Reddy P, Ferrara JL. Graft-Versus-Host Disease and Graft-Versus-Leukemia Responses. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00108-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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4
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Taimur S, Nader C, Lloyd-Travaglini C, Seldin D, Sanchorawala V. Microbiologically documented infections in patients undergoing high-dose melphalan and autologous stem cell transplantation for the treatment of light chain amyloidosis. Transpl Infect Dis 2012; 15:187-94. [DOI: 10.1111/tid.12037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 07/26/2012] [Accepted: 08/15/2012] [Indexed: 11/29/2022]
Affiliation(s)
- S. Taimur
- Section of Infectious Diseases; Boston Medical Center; Boston University School of Medicine; Boston; Massachusetts; USA
| | - C. Nader
- Section of Infectious Diseases; Boston Medical Center; Boston University School of Medicine; Boston; Massachusetts; USA
| | - C. Lloyd-Travaglini
- Data Coordinating Center; Boston University School of Public Health; Boston; Massachusetts; USA
| | - D.C. Seldin
- Section of Hematology/Oncology; Department of Medicine; Boston Medical Center; Boston University School of Medicine; Boston; Massachusetts; USA
| | - V. Sanchorawala
- Section of Hematology/Oncology; Department of Medicine; Boston Medical Center; Boston University School of Medicine; Boston; Massachusetts; USA
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5
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van der Velden AMT, Claessen AME, van Velzen-Blad H, Biesma DH, Rijkers GT. Development of T cell-mediated immunity after autologous stem cell transplantation: prolonged impairment of antigen-stimulated production of gamma-interferon. Bone Marrow Transplant 2007; 40:261-6. [PMID: 17563737 DOI: 10.1038/sj.bmt.1705706] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The conditioning regimens for autologous SCT (auto-SCT) lead to impairment of the immune system and concomitant increase in susceptibility to infections. We studied the recovery of cellular immunity by in vitro analysis of T-cell proliferation and cytokine production profiles during the first 15 months after auto-SCT in patients with multiple myeloma and non-Hodgkin's lymphoma. PBMC were collected at 6, 9 and 15 months after transplantation and stimulated with a combination of CD2 and CD28 monoclonal antibodies, with PHA or with tetanus toxoid as recall antigen. A multiplex enzyme linked immunoassay was used to determine levels of Th1 cytokines IL-2, IFN-gamma and tumour-necrosis factor-alpha (TNF-alpha), Th2 cytokines IL-4, IL-5 and IL-13, the regulatory cytokine IL-10 and the proinflammatory cytokines IL-1alpha, IL-1beta, IL-6 and the chemokine IL-8. T-cell proliferation progressively increased from 6 to 15 months after auto-SCT. Overall, cytokine production increased after auto-SCT. Production of Th2 cytokines IL-5 and IL-13 was superior to production of Th1 cytokines IFN-gamma and TNF-alpha. We hypothesize that prolonged impairment of IFN-gamma production might contribute to the relatively high incidence of viral infections after auto-SCT.
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Affiliation(s)
- A M T van der Velden
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands.
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6
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Schütt P, Brandhorst D, Stellberg W, Poser M, Ebeling P, Müller S, Buttkereit U, Opalka B, Lindemann M, Grosse-Wilde H, Seeber S, Moritz T, Nowrousian MR. Immune parameters in multiple myeloma patients: influence of treatment and correlation with opportunistic infections. Leuk Lymphoma 2006; 47:1570-82. [PMID: 16966269 DOI: 10.1080/10428190500472503] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The present study evaluated cellular and humoral immune parameters in myeloma patients, focusing on the effect of treatment and the risk of opportunistic infections. Peripheral blood lymphocyte subsets and serum levels of nonmyeloma immunoglobulins (Ig) were analysed in 480 blood samples from 77 myeloma patients. Untreated myeloma patients exhibited significantly reduced CD4+/45RO+, CD19+, CD3+/HLA-DR+, and natural killer (NK) cells, as well as nonmyeloma IgA, IgG and IgM. Conventional-dose chemotherapy resulted in significantly reduced CD4+ and even further decline of CD4+/CD45RO+ and CD19+ cells, most notably in relapsed patients. Additional thalidomide treatment had no significant effects on these parameters. Following high-dose chemotherapy (HD-CTX), prolonged immunosuppression was observed. Although CD8+, NK, CD19+ and CD+/CD45RO+ cells recovered to normal values within 60, 90, 360 and 720 days, respectively, CD4+ counts remained reduced even thereafter. Nine opportunistic infections were observed, including five cytomegalovirus (CMV) diseases, one Pneumocystis carinii pneumonia (PCP) and three varicella zoster virus infections with CMV diseases and PCP occurring exclusively after HD-CTX. Opportunistic infections were correlated with severely reduced CD4+, as well as CD4+/CD45RO+ and CD19+ counts. Thus, myeloma patients display cellular and humoral immunodeficiencies, which increase following conventional as well as HD-CTX, and constitute an important predisposing factor for opportunistic infections.
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Affiliation(s)
- Philipp Schütt
- Department of Internal Medicine (Cancer Research), West German Cancer Center, University of Duisburg-Essen Medical School, Essen, Germany.
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7
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Kim H, Sohn HJ, Kim SE, Kang HJ, Park S, Kim S, Kim WK, Lee JS, Suh C. Lymphocyte recovery as a positive predictor of prolonged survival after autologous peripheral blood stem cell transplantation in T-cell non-Hodgkin's lymphoma. Bone Marrow Transplant 2005; 34:43-9. [PMID: 15107814 DOI: 10.1038/sj.bmt.1704530] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We performed a retrospective study on recovery and survival of patients with T-cell NHL after autologous peripheral blood stem cell transplantation (APBSCT). Of a total of 39 patients with high-risk T-cell NHL, 33 were analyzed. Six patients who experienced early treatment mortality without full lymphocyte recovery were excluded. We chose absolute lymphocyte count (ALC) recovery as 1000 cells/microl as a cutoff value. ALC recovery day was defined as the first of 3 consecutive days with ALC above 1000 cells/microl. Univariate analysis revealed that age younger than 45 years, good international prognostic index, chemosensitive disease prior to APBSCT, and early ALC recovery (1000 cells/microl within 25 days of APBSCT) were predictors of prolonged survival. Multivariate analyses confirmed that chemosensitive disease prior to APBSCT and early ALC recovery were strongly associated with better overall survival (OS) (P=0.005 and 0.011, respectively) and progression-free survival (PFS) (P<0.001 and P=0.013, respectively). Our finding, that ALC recovery > or =1000 cells/microl is an independent predictor of OS and PFS in T-cell NHL after APBSCT, suggests that earlier immune recovery may contribute to longer survival.
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Affiliation(s)
- H Kim
- Division of Hematology-Oncology, ASAN Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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8
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Porrata LF, Gertz MA, Litzow MR, Lacy MQ, Dispenzieri A, Inwards DJ, Ansell SM, Micallef IN, Gastineau DA, Elliott M, Hogan WJ, Hayman SR, Tefferi A, Markovic SN. Early Lymphocyte Recovery Predicts Superior Survival after Autologous Hematopoietic Stem Cell Transplantation for Patients with Primary Systemic Amyloidosis. Clin Cancer Res 2005. [DOI: 10.1158/1078-0432.1210.11.3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: Absolute lymphocyte count recovery at day 15 (ALC-15) post-autologous stem cell transplantation (ASCT) is a powerful prognostic indicator for survival for multiple hematologic malignancies and metastatic breast cancer. The relationship of ALC-15 with clinical outcomes in primary systemic amyloidosis is unknown.
Experimental Design: We evaluated 145 consecutive patients with primary systemic amyloidosis who underwent ASCT at the Mayo Clinic from 1996 to 2003. The ALC-15 threshold was set at 500 cells/μL based on our previous observations.
Results: The median patient follow-up was 22 months (range, 3-87 months). Higher hematologic complete response was observed in patients with an ALC-15 ≥ 500 cells/μL compared with patients with an ALC-15 < 500 cells/μL (41% versus 21%, P < 0.0008, respectively). The median overall survival and progression-free survival times were significantly better for the 59 patients that achieved an ALC-15 ≥ 500 cells/μL compared with 86 patients with ALC-15 < 500 cells/μL (not reached versus 53 months, P < 0.0003 and not reached versus 27 months, P < 0.0001, respectively). Multivariate analysis showed ALC-15 to be an independent prognostic factor for overall survival and progression-free survival.
Conclusions: ALC-15 ≥ 500 cells/μL is associated with significantly improved clinical outcomes following ASCT in patients with primary systemic amyloidosis.
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Affiliation(s)
- Luis F. Porrata
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Morie A. Gertz
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mark R. Litzow
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Martha Q. Lacy
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Angela Dispenzieri
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - David J. Inwards
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Stephen M. Ansell
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ivanna N.M. Micallef
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Dennis A. Gastineau
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michele Elliott
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - William J. Hogan
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Suzanne R. Hayman
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ayalew Tefferi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Svetomir N. Markovic
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
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9
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Wendelbo Ø, Nesthus I, Sjo M, Ernst P, Bruserud Ø. Cellular immune responses in multiple myeloma patients with treatment-induced cytopenia early after high-dose chemotherapy and autologous peripheral blood stem cell transplantation. Leuk Res 2004; 28:461-8. [PMID: 15068899 DOI: 10.1016/j.leukres.2003.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2003] [Accepted: 09/09/2003] [Indexed: 11/19/2022]
Abstract
Proliferative T cell responses were compared for two patient groups with severe treatment-induced leukopenia (white blood cell counts < 0.5 x 10(9)/l): (i). multiple myeloma patients receiving high-dose melphalan and autologous peripheral blood stem cell transplantation; (ii). patients receiving conventional intensive chemotherapy for acute leukemia or myelodysplasia. Although the majority of circulating leukocytes were CD2(+)TCRalphabeta(+) in both groups, the myeloma patients showed significantly lower T cell proliferation in responses to several activation signals (anti-CD3, anti-CD3 + IL2, anti-CD3 + anti-CD28, anti-CD3 + anti-CD28+IL2. Our results suggest that myeloma patients with post-transplant cytopenia have a more severe cellular immune defect than patients with other hematological malignancies and severe cytopenia due to conventional intensive chemotherapy.
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Affiliation(s)
- Øystein Wendelbo
- Department of Medicine, Haukeland University Hospital, N-5021 Bergen, Norway.
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10
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Gertz MA, Lacy MQ, Dispenzieri A. Therapy for immunoglobulin light chain amyloidosis: the new and the old. Blood Rev 2004; 18:17-37. [PMID: 14684147 DOI: 10.1016/s0268-960x(03)00027-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
An accurate diagnosis of amyloidosis and its subtype classification are essential for disease prognostication and treatment. In primary amyloidosis, overall median survival is approximately 2 years and may be less in patients with cardiomyopathy. Current therapy for primary amyloidosis is suboptimal. Controlled studies suggest that treatment with melphalan and prednisone may provide marginal survival benefit. A more aggressive approach such as autologous hematopoietic stem cell transplantation may offer potential for long-term benefit. Although patients undergoing autologous hematopoietic stem cell transplantation are highly selected, response rates can approach 60%, and patients with amyloidosis who respond to treatment have potential for long-term survival. New treatment modalities that were shown to have antitumor activity in multiple myeloma (high-dose dexamethasone and thalidomide) may also be of therapeutic value in primary amyloidosis. Systemic chemotherapy would not be expected to have any beneficial effect on other forms of amyloid and carries significant risk.
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Affiliation(s)
- Morie A Gertz
- Division of Hematology and Internal Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
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11
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Dayyani F, Joeinig A, Ziegler-Heitbrock L, Schmidmaier R, Straka C, Emmerich B, Meinhardt G. Autologous stem-cell transplantation restores the functional properties of CD14+CD16+ monocytes in patients with myeloma and lymphoma. J Leukoc Biol 2003; 75:207-13. [PMID: 14576364 DOI: 10.1189/jlb.0803386] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The CD14+CD16+ monocytes appear to be important to immune defense against infection, as these cells are very potent with respect to tumor necrosis factor (TNF) production, phagocytosis, and antigen presentation. Myeloablative high-dose chemotherapy (HDT) and subsequent autologous stem-cell transplantation (ASCT) are being used increasingly for therapy of hematological malignancies, but the pronounced immunosuppression renders the patients prone to infection. To determine the functional properties of CD14+CD16+ monocytes under these conditions, 15 patients with lymphoma or myeloma were examined. Before HDT, the ratio of CD14+CD16+ cells to the population of the classical CD14++ monocytes was 0.28 +/- 0.12; this ratio changed during the course of HDT and ASCT in favor of the CD14+CD16+ monocytes to a maximum of 12.4 +/- 7.8 (P<0.001) on day 3.5 +/- 1.6 after transplanation (Tx) and returned to 0.11 +/- 0.07 (P<0.001) after engraftment on day 11.3 +/- 2.2. Although the absolute number of classical CD14++ monocytes declined to less than 1/microl at the nadir, the number of CD14+CD16+monocytes fell from 29.7 +/- 9.8/microl to 4.5 +/- 3.0/microl at the nadir and increased to 13.8 +/- 9.8/microl at the day of discharge from the hospital. Flow cytometric analysis of phagocytosis of fluorescein isothiocyanate (FITC)-labeled Escherichia coli showed that 30 +/- 10% CD14+CD16+ monocytes of patients were FITC-positive before Tx, and at engrafment, the percentage of FITC-positive cells had doubled to 60 +/- 6% (healthy controls, 41+/-7%). When determining generation of reactive oxygen species after E. coli ingestion, the CD14+CD16+ monocytes showed a decreased response before Tx (32+/-12% positve cells), which increased to 53 +/- 24% after ASCT. The median fluorescence intensity of human leukocyte antigen (HLA)-DR expression on the CD14+CD16+ monocytes increased from 11 +/- 6 before Tx to 17 +/- 11 after Tx, and the production of TNF after lipopolysaccharide showed no remarkable difference (46+/-13 vs. 49+/-14 channels). At the same time, expression of TNF and of HLA-DR showed a dramatic decrease in the CD14++ monocytes. Taken together after stem-cell Tx, the function of the CD14++ monocytes is impaired, and the functional properties of CD14+CD16+ monocytes recover, indicating that these cells may be important for defense against infections post-ASCT.
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Affiliation(s)
- Farshid Dayyani
- Department of Hematology and Oncology, Medical Clinic Campus Innenstadt, University of Munich, Ziemmssenstrasse 1, 80336 Munich, Germany.
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12
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Reimer P, Kunzmann V, Wilhelm M, Weissbrich B, Kraemer D, Berghammer H, Weissinger F. Cellular and humoral immune reconstitution after autologous peripheral blood stem cell transplantation (PBSCT). Ann Hematol 2003; 82:263-70. [PMID: 12739062 DOI: 10.1007/s00277-003-0630-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2002] [Accepted: 01/30/2003] [Indexed: 10/25/2022]
Abstract
Immune reconstitution after autologous peripheral blood stem cell transplantation (PBSCT) is of particular interest because of its importance for clinical outcome. Despite prolonged immunosuppression, especially of CD4(+) cells, few infections after neutrophil recovery occur. Only reactivation of varicella zoster virus (VZV) is more frequent in the first year after transplantation. From August 1997 to May 2001, we prospectively evaluated 38 patients prior to conditioning and during follow-up of 12 months post-transplant for virus antibodies [measles, mumps, rubella, polio, herpes simplex, varicella zoster, mononucleosis, cytomegalovirus (CMV)] and lymphocyte subpopulations by flow cytometry. CD3(+) T lymphocytes, CD8(+) T cells, and B-lymphocyte reconstitution in our study confirms previous reports. Complete CD4(+) lymphocyte reconstitution was not achieved in the 12 months post-transplant leading to a suppressed CD4/CD8 ratio. IgG antibody titers against measles, mumps, rubella, and polio were present in almost all patients pretransplant and during 12 months post-transplant, indicating persistent humoral immunity. CD3(+) and CD8(+) counts of patients with clinical VZV reactivation ( n=5) post-transplant were significantly higher (median: 1201/microl and 938/microl, respectively) than in patients without VZV reactivation (median: 594/microl and 482/microl, respectively) 6-12 months post-transplant. Positive CMV titers pretransplant ( n=19) were also correlated with higher CD3(+) and CD8(+) counts 3-6 months post-transplant (median: 1050/microl and 1056/microl, respectively) compared to CMV-negative patients (738/microl and 584/microl, respectively), although none of the patients suffered from CMV disease. Therefore, we conclude that persistent viral infections can contribute to the CD8(+) T-cell reconstitution after PBSCT by oligoclonal expansion of antigen-specific memory CD8(+) T cells.
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Affiliation(s)
- P Reimer
- Medizinische Poliklinik, Universität Würzburg, Klinikstr. 6-8, 97070, Würzburg, Germany.
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